Publication Status Research Articles

Percutaneous nephrolithotomy vs retrograde intrarenal surgery for renal stones: a Cochrane Review.

To assess the effects of percutaneous nephrolithotomy (PCNL) vs retrograde intrarenal surgery (RIRS) for the treatment of renal stones in adults. We performed a comprehensive search of the Cochrane Library, MEDLINE, Embase, three other databases, trials registries, other sources of the grey literature, and conference proceedings up to 23 March 2023. We applied no restrictions on publication language or status. Screening, data extraction, risk-of-bias assessment, and certainty of evidence (CoE) rating using the Grading of Recommendations Assessment, Development and Evaluations (GRADE) approach were done in duplicate by two independent reviewers. This co-publication focuses on the primary outcomes of this review only. We included 42 trials that met the inclusion criteria. Stone-free rate (SFR): PCNL may improve SFRs (risk ratio [RR] 1.13, 95% confidence interval [CI] 1.08-1.18; I2 = 71%; 39 studies, 4088 participants; low CoE). Major complications: PCNL probably has little to no effect on major complications (RR 0.86, 95% CI 0.59-1.25; I2 = 15%; 34 studies, 3649; participants; moderate CoE) compared to RIRS. Need for secondary interventions: PCNL may reduce the need for secondary interventions (RR 0.31, 95% CI 0.17-0.55; I2 = 61%; 21 studies, 2005 participants; low CoE) compared to RIRS. Despite shortcomings in most studies that lowered our certainty in the estimates of effect to mostly very low or low, we found that PCNL may improve SFRs and reduce the need for secondary interventions while not impacting major complications. Ureteric stricture rates may be similar compared to RIRS. We expect the findings of this review to be helpful for shared decision-making about management choices for individuals with renal stones.

A systematic review and meta-regression analysis of technical efficiency in Ethiopian wheat farming

Replications are important for science, both statistically and philosophically. A plethora of empirical studies that have been done so far show that there are always variations, errors and inconclusive findings on the technical efficiency (TE) scores of wheat output in Ethiopia. In this study, we intend to contribute to these controversies by providing the first thorough investigation of the magnitude of mean-effect size and the underlying factors of mean technical efficiency variations in wheat production across studies in Ethiopia. These efficiency scores are retrieved from 31 studies, or a household size of 12,754 over the years 2011–2022. The analysis of meta-regression was done using a random effect model using Comprehensive Meta-analysis (CMA-4) software. The Begg and Mazumdar rank-correlation test, egger test, and funnel plot were used to determine publication bias across studies. Since 2022, we have utilized the classic fail-safe-N test. One issue with publication bias is the omission of some non-significant studies from the analysis, which, if they were included, would cancel out the observed effect. Further, the missing study problem or “file drawer” problem, of the study would also be computed using the “Trim and Fill” estimation approach. To evaluate heterogeneity, a forest plot is used. The effect size is also determined using the random effect model along with the I-squared statistic, the tau-squared and tau, and the Q-test. As a result, a mean effect size of 71.6% with a 95% confidence interval of 67.9%−75.3% is observed. The meta-regression demonstrates that the 31 mean technical efficiency studies included in the research had varying efficiency scores due to variations in sample size, methodologies used, publication status, and study range. It suggests that, with all other factors held constant, a 1% change in these regressors causes a 0.01%, 10.88%, 21.22%, and 6.74% change, respectively, in the mean technical efficiency scores across studies in Ethiopia. In addition, the technical efficiency score across studies is also affected by the location in which the study is conducted.

Gender and Racial Diversity in Relation to Publication Rates at the Canadian Association of Radiology Annual Scientific Meetings 2016 to 2019.

Purpose: To determine the overall rate of publication of abstracts presented at the 2016 to 2019 Canadian Association of Radiology Annual Scientific Meeting (CAR ASM), with an emphasis on gender and racial diversity. Methods: Abstracts from publicly available past programs were analyzed using PubMed, EMBASE, and Google Scholar for publication status, time to publication (TTP), author affiliation, and journal of publication. Past programs were used to determine the abstract format, abstract category, and the subspecialty and imaging modalities explored. First author demographics were identified using the Namsor software. Results: Four hundred and sixty-two abstract presentations were included in the analysis with an overall conversion rate of 34.63%. Two hundred and ninety-two (63.2%) of the first-authors were male-identified, of which 104 (35.62%) were published. In contrast, 170 (36.8%) were female-identified, of which 56 (32.94%) were published. Additionally, 50.87% first-authors were identified as white, 38.31% asian, 6.06% black, 4.76% latino, and 0.00% indigenous. While diversity was seen in demographics, 60% of publications had a white first-author. The following conversion rates were found: 40.85% white, 30.51% asian, 25% black, and 13.64% latino. In terms of abstract category, radiologist-in-training had the highest conversion rate at 60.71%. The median TTP was 14 months, with an average impact factor of 5.26. Conclusion: Less than half of abstracts at the 2016 to 2019 CAR ASM were published and both gender and racial disparities in relation to conversion rates were identified. Measures to improve publication rates and overall diversity in Radiology are warranted.

Anti-PD-1/PD-L1 for nasopharyngeal carcinoma: a comprehensive analysis of registered trials on ClinicalTrials.gov.

Objective: Clinical trials play an important role in the development of healthcare. However, the current status of clinical trials on anti-PD-1/PD-L1 for nasopharyngeal carcinoma remains unclear. Therefore, this study aims to provide a comprehensive analysis of the registered trials related to anti-PD-1/PD-L1 for nasopharyngeal carcinoma on ClinicalTrials.gov. Methods: A search was conducted on the ClinicalTrials.gov database to identify all registered trials related to anti-PD-1/PD-L1 for nasopharyngeal carcinoma up to 26 February 2023. The characteristics of the trials were examined, and the studied drugs, disease conditions, as well as details of trials with available results were analyzed. Publication status was assessed by a PubMed search using the ClinicalTrials.gov NCT number. Results: A total of 112 interventional clinical trials registered between 2015 and 2023 were included. Of the trials, 90 were carried out in Asia, 72 were in phase 2, and 31 trials had either companies or universities as sponsors/collaborators. The sample sizes across the trials varied greatly, with a median of 71.5 participants per trial. The majority of trials were recruiting participants, with only 6 had posted results. PD-1 inhibitors were preferred over PD-L1, and Toripalimab emerged as the most extensively studied drug. About one-third (33.9%) of the studies looked into recurrent/metastatic nasopharyngeal cancer. Conclusion: This study provides an overview of all registered trials of anti-PD-1/PD-L1 for NPC. It is needed to improve the completeness, outcome selection, randomization and masking of trials and to be transparent and timely in reporting of results.

Facial palsy induced by immune checkpoint blockade: A systematic analysis of clinical trials and a pharmacovigilance study of postmarketing data

BackgroundTo estimate the risk of facial nerve palsy (FP) associated with immune checkpoint inhibitors (ICIs), and to describe its clinical features. MethodsData from randomized controlled trials (RCTs) and FDA Adverse Event Reporting System (FAERS) database were included. The primary outcome was the risk of FP events associated with ICIs. For data from RCTs, pooled analysis was performed by using risk ratios (RRs) with 95%CIs. In a separate retrospective pharmacovigilance study of FAERS, disproportionality was analyzed using the proportional reports reporting odds ratio (ROR) and information components (IC). ResultsA total of 21 RCTs (193,05 patients) were included, ICIs were associated with increased risk of FP (OR = 3.07, 95%CI:1.43–6.58). Results of subgroup analysis indicated that OR of ICI-related FP did not vary significantly by tumor type, ICIs treatment schedule, case of events, study design, median PFS and publication status. FAERS pharmacovigilance data identified 274 cases of FP related to ICIs therapy. ICIs were significantly associated with over-reporting frequencies of FP (ROR = 3.03, 95%CI:2.69–3.42; IC = 1.56, 95%CI:1.38–1.76). The median onset time of FP was 5.5 weeks, drug interruption was recorded in 78.0% of cases, with a positive dechallenge in 82.8 % of cases, and 71.7% of cases were recovered or recovering. ConclusionsThese data suggest that ICIs were significantly associated with increased risk of FP in both trial settings and in clinical practice.

Association of late-gadolinium enhancement on cardiac magnetic resonance with cardiovascular outcomes and mortality in patients with aortic stenosis

Abstract Background Late-gadolinium enhancement (LGE) on cardiac magnetic resonance has been associated with increased risk of adverse events in various clinical settings. This association in patients with aortic stenosis is not well established. Purpose This meta-analysis assessed the association between LGE on CMR with all-cause moratlity, cardiovascular (CV) mortality, and major adverse cardiovascular events (MACE) in patients with aortic stenosis. Methods A literature search was conducted for studies reporting the association between LGE in aortic stenosis and the primary endpoint of all-cause mortality. Secondary endpoints included CV mortality and MACE. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. The minimum duration of follow-up was 12 months. Results A total of 11 studies and 2527 patients (1279 with LGE vs 1248 without LGE) were included; mean follow up was 30 months (ranging between 12 to 52 months). LGE is associated with increased risk of all-cause mortality on long-term follow-up (odds ratio 2.87, 95% confidence interval 2.03-4.04; P<0.01). Heterogeneity was low-moderate: Chi2= 12.28, df8, I2 =35%. Subgroup analysis of only patients who underwent aortic valve replacement demonstrated that LGE is associated with increased risk of all-cause mortality on long-term follow-up (OR 2.49, 95% CI 1.94-3.20; P<0.01). For secondary endpoints, LGE was not associated with a statistically significant increase in risk of CV mortality or MACE, however there is a trend toward increased risk (OR 2.43, 95% CI 0.95-6.23; P = 0.06; OR 2.33, 95% CI 0.86-6.28; P=0.09). Conclusions Our results suggest that LGE is associated with increased risk of all-cause mortality in patients with aortic stenosis regardless of whether aortic valve replacement is performed. LGE was not associated with a statistically significant increased risk of CV mortality or MACE, however additional high quality prospective studies are needed to further evaluate these endpoints.

Association of device detected atrial high rate episodes with embolic events

Abstract Background Subclinical atrial fibrillation (AFib) is a common etiology of embolic events such as embolic strokes of undetermined source. With the advent of cardiac implantable electronic devices (CIED), there has been increased detection of subclinical AFib, or atrial high rate episodes (AHRE) in asymptomatic patients without a known diagnosis of AFib. The clinical significance of AHRE detected with CIED remains poorly characterized with studies reporting conflicting results. The purpose of this meta-analysis is to evaluate the association of AHRE with cerebrovascular accidents (CVA), transient ischemic attacks (TIA), and systemic embolic events. Methods A literature search was conducted for studies reporting on the association of subclinical AFib or AHRE with CVA, TIA, and systemic embolic events. The search included the following databases: Ovid MEDLINE, EMBASE, Google Scholar, and Web of Science. The search was not restricted to time or publication status. Results A total of 19 studies and 50,968 patients (12,879 with AHRE vs 38,089 without AHRE) were included. Mean follow-up was 32 months, mean age was 72 years old, 53.3% were male. Patients with device detected AHRE had increased risk of composite endpoint of CVA, TIA, and systemic embolic events (OR 2.98, 95% CI 2.03-4.39; P<0.01). Subgroup analysis by maximum AHRE burden demonstrated that both maximum AHRE burden >24 hours and burden <24 hours are associated with increased risk of CVA, TIA, and systemic embolic events (OR 4.82, 95% CI 2.07-11.24; p<0.01; OR 1.55, 95% CI 1.11-2.15; p<0.01). The overall effect size is larger for maximum AHRE burden >24 hours compared to <24 hours (Z=3.64 vs Z=2.61). Conclusions Our results suggest that AHRE detected with CIED is associated with increased risk of CVA, TIA, and systemic embolic events regardless of maximum AHRE burden >24 hours or <24 hours. Additional studies are required to determine the utility anticoagulation therapy for treatment of asymptomatic patients with device detected AHRE.

Association of myocardial infarction with nonobstructive coronary arteries with long-term outcomes

Abstract Background Myocardial Infarction with Non-obstructive Coronary Arteries (MINOCA) is a disease classification that is not uncommonly encountered yet poorly characterized. The association of MINOCA with long-term cardiovascular (CV) outcomes has been inconsistently assessed with studies reporting conflicting results. The purpose of this meta-analysis is to evaluate the association of MINOCA with long-term cardiovascular outcomes. Methods A literature search was conducted for studies reporting on the association of MINOCA with clinical endpoints as compared to obstructive coronary artery disease (OCAD). The primary end-point was all-cause mortality. Secondary endpoints included CV mortality, need for revascularization, recurrence of acute coronary syndrome (ACS), CV rehospitalization, persistent angina after discharge, and major adverse cardiac events (MACE). Databases searched included Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. Results A total of 29 studies with 893134 patients with acute myocardial infarction (AMI) (48425 with MINOCA, 844709 with OCAD) met inclusion criteria. Mean follow-up was 39 months, mean age was 62, 66% were male. MINOCA was associated with significantly lower risk of all-cause mortality compared to OCAD (OR 0.69, 95% CI 0.60-0.78; p<0.01). The overall effect size was large (z=5.72). MINOCA was associated with significantly lower risk of CV mortality, need for revascularization, recurrent ACS, and persistent angina after discharge (OR 0.49, 95% CI 0.36-0.67; p<0.01; OR 0.09, 95% CI 0.03-0.31; p<0.01; OR 0.57, 95% CI 0.37-0.89; p=0.01; OR 0.23, 95% CI 0.11-0.51; p<0.01). MINOCA was not associated with a significant difference in risk of CV rehospitalization (OR 0.74, 95% 0.46-1.19; p=0.21). Conclusions In patients with AMI, MINOCA is associated with lower risk of all-cause mortality, CV mortality, need for revascularization, recurrent ACS, and persistent angina on long-term follow-up compared to OCAD. However, MINOCA is associated with similar risk of rehospitalization for CV events. Further studies are needed to determine the association between different medical therapies and clinical outcomes in patients with MINOCA.

Effect of ICD on patients with improved EF in idiopathic dilated cardiomyopathy

Abstract Background The efficacy of implantable cardioverter defibrillator (ICD) therapy in patients who had heart failure with improved ejection fraction (HFimpEF) above guidelines indication for ICD (>35%) during generator change is still controversial. This meta-analysis assesses the impact of ICD therapy in patients with HFimpEF with EF >35% and patient with NICM. Methods Databases were searched for studies reporting the association between ICD in patients with NICM and HFimpEF and ventricular arrhythmias (VA) and sudden cardiac death (SCD); including Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. The minimal follow up duration was one year. Results A total of 38 studies and 13,538 patients (5,829 with improved EF vs 7,709 with EF <35% during follow up) were included; mean follow up was 43 months (ranging between 12 to 74 months). Mean age was 63.5 and 75% were males. Patients with HFimpEF with ICD, wither alone or as part of CRT therapy, was associated with lower risk of VA and SCD (OR 0.39, 95% CI 0.32-0.47; P<0.01; annual rate 4.1 vs. 8%). Sub-analysis for patients with ICD for patient with NICM was associated with lower risk of VA and SCD (OR 0.25, 95% CI 0.1-0.62; P<0.01; annual rate 2.9 vs. 10.2%). (Figure) Conclusion Improved EF is associated with reduced VA but with still elevated risk in HFimpEF especially in NICM.

Association of anticoagulation with outcomes in patients with infective endocarditis

Abstract Background Infective endocarditis (IE) is a disease that is associated with high risk of morbidity and mortality. The utility of systemic anticoagulation (AC) in patients with IE has not been well defined. The purpose of this meta-analysis is to evaluated the utility of AC in patients with IE. Methods A literature search was conducted for studies reporting on the use of AC in patients with IE and clinical endpoints. The primary endpoint was all neurological complications. Secondary endpoints included all-cause mortality, ischemic cerebral vascular accident (CVA), and hemorrhagic CVA. Databases searched included Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted by time or publication status. Results A total of 12 studies with 9,063 participants with IE (1994 on AC, 7069 not on AC) met inclusion criteria. Mean age was 58 years, 65.8% were men, 20.9% had prosthetic valves. There was no statistically significant difference in risk of neurological complications in patients on AC compared to patients not on AC (OR 0.88, 95% CI 0.68-1.12; p=0.30). There was a trend towards increased risk of all-cause mortality in patients treated with AC compared to patients not on AC (OR 1.27, 95% CI 0.99-1.63; p=0.06). Patients on AC had significantly higher risk of hemorrhagic CVA compared to patients not on AC (OR 1.51, 95% CI 1.05-2.19; p=0.03). There was no statistically significant difference in risk of ischemic CVA in patients on AC compared to patients not on AC (OR 1.10, 95% CI 0.89-1.37; p=0.37). Conclusions Use of anticoagulation in patients with infective endocarditis is not associated with reduction in risk of neurological complications and may increase risk of all-cause mortality and hemorrhagic CVA. Further high quality studies are required to further characterize the use of anticoagulation in this disease process.

Association of revascularization with mortality in ischemic left ventricular dysfunction

Abstract Background Revascularization in patients with left ventricular (LV) dysfunction has been a subject of ongoing uncertainty and conflicting results. This is further complicated by factors including viability, severity of LV dysfunction, and method of revascularization using percutaneous coronary intervention (PCI) versus coronary-artery bypass grafting (CABG). The purpose of this meta-analysis is to evaluate the association of coronary revascularization with mortality in patients with ischemic LV dysfunction. Methods A literature search was conducted for studies reporting on all-cause mortality after revascularization with PCI or CABG compared to optimal medical therapy (OMT) in patients with ischemic LV dysfunction. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. Results A total of 21 studies with 6062 participants (2838 revascularized, 3224 on OMT) met inclusion criteria. Mean follow-up was 37 months (11-68 months), mean LV ejection fraction (EF) was 29%, mean age was 61, 85% of patients were male. Revascularization was significantly associated with lower all-cause mortality compared to patients on OMT (OR 0.57, 95% CI 0.46-0.71; p<0.01). The association was statistically significant regardless of severity of LV dysfunction or method of revascularization. Heterogeneity between subgroups was low and test for subgroup difference was not statistically significant by EF cutoff of 35% or by revascularization method (p=0.43, I2=0%; p=0.12, I2=59.7%). Subgroup analysis by viability demonstrated that revascularization was significantly associated with lower all-cause mortality compared to OMT for patients with viability and mixed cohorts with or without viability, but not patients without viability (OR 0.47, 95% CI 0.33-0.66; p<0.01; OR 0.57, 95% CI 0.38-0.84; p<0.01; OR 0.73, 95% CI 0.51-1.02; p=0.07). The effect size was larger in the subgroup with viable myocardium compared to mixed patients with viable or non-viable myocardium (Z=4.33 vs 2.79). Conclusions Revascularization in patients with ischemic LV dysfunction is associated with lower risk of all-cause mortality independent of severity of LV dysfunction or method of revascularization. Revascularization is not associated with lower risk of all-cause mortality in patients without evidence of viable myocardium.

LGE in CMR and outcomes in cardiac sarcoidosis

Abstract Background Late-gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is a predictor of adverse events in patients with cardiac sarcoidosis (CS). This meta-analysis evaluated the correlation between LGE and mortality, ventricular arrhythmias (VA), sudden cardiac death (SCD), and heart failure (HF) outcomes. Methods A literature search was conducted for studies reporting the association between LGE in CS and the study endpoints. The endpoints are: mortality, VA and SCD, and HF hospitalization. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. The minimum follow-up duration was one year. Results A total of 17 studies and 1,915 CS patients (595 with LGE vs 1,320 without LGE) were included; mean follow-up was 3.3 years (ranging between 17 to 84 months). LGE was associated with increased all-cause mortality (OR 6.05, 95% CI 3.16-11.58; P<0.01), cardiovascular mortality (OR 5.83, 95% CI 2.89-11.77; P<0.01) and VA and SCD (OR 16.48, 95% CI 8.29-32.73; P<0.01). The presence of LGE in the right ventricle is associated with higher risk of VT (OR 6.11, 95% CI 1.14-32.68; P 0.035). LGE was associated with an increased risk of HF hospitalization (OR 17.47, 95% CI 5.54-55.03; P<0.01). Conclusion LGE in CS patients is associated with increased mortality, VA and SCD, and HF hospitalization during long-term follow up. The presence of LGE in the right ventricle is associated with higher risk of VT.

The effectiveness of high-intensity interval training compared to moderate-intensity continuous training in patients with heart failure: a systematic review and meta-analysis

Abstract Background/Introduction Cardiac rehabilitation including exercise therapy is beneficial for improving exercise tolerance, physical function, quality of life (QOL), and life expectancy in patients with heart failure. High-intensity interval training (HIIT) has attracted attention as a new training modality in heart failure, whereas moderate-intensity continuous aerobic training (MCT) is recommended as the main training modality to improve exercise tolerance. However, the effects of HIIT in patients with heart failure remain controversial. Purpose This systematic review and meta-analysis aimed to examine the effectiveness of HIIT compared to MCT on exercise tolerance in patients with heart failure. Methods We searched for studies published up to 4 March 2022 in EMBASE, MEDLINE via Ovid SP, PubMed, and the Cochrane Library via Wiley Online Library with no limitations on data, language, or publication status. We included randomised controlled trials comparing the effectiveness of HIIT and MCT on peak oxygen uptake (VO2), as a measure of exercise tolerance, aerobic threshold (AT) VO2, ventilatory equivalent of carbon dioxide (VE/VCO2), and QOL. We pooled the data on peak VO2, compared HIIT to MCT, and conducted a sub-analysis if there was heterogeneity in the result. Results We identified 15 randomised controlled trials with 557 patients from a total of 23,272 records. Our meta-analysis showed that participants who underwent HIIT achieved a significantly higher peak VO2 than those who underwent MCT (mean difference 1.46 ml/kg/min, 95% confidence interval 0.39 to 2.53; I2 = 65.7%; very low-quality evidence) (Figure 1). Participants who underwent HIIT had no statistically significant difference in AT VO2, VE/VCO2, and QOL compared to those who underwent MCT. The meta-regression analysis, conducted as a sub-analysis to explore possible causes of heterogeneity, revealed that the effect size of HIIT compared to MCT was inversely associated with body mass index (r = -0.508, p = 0.028, 95% confidence interval -0.95 to -0.07) (Figure 2). Conclusions Our systematic review showed that HIIT achieved a higher peak VO2 than MCT in patients with heart failure. In addition, HIIT may be more effective in improving exercise tolerance in patients with low body mass index.

Utility of fractional flow reserve computed tomography angiography in patients with stable coronary artery disease

Abstract Introduction Coronary CT angiography (CTA) has been established as an effective non-invasive modality for evaluation of patients with low-intermediate pretest probability of coronary artery disease (CAD). The utility of CTA is limited due to certain lesion characteristics. Fractional Flow Reserve Computed Tomography (FFRCT) may be useful in these situations, however the association of FFRCT with clinical outcomes has not been well established. The purpose of this study is to evaluate the association of FFRT with clinical outcomes in patients with stable coronary artery disease. Methods A literature search was conducted for studies reporting the association between FFRCT measurements and all-cause mortality, major adverse cardiac events (MACE), acute myocardial infarction (AMI), and need for revascularization. FFRCT value of ≤0.80 was considered positive, FFRCT value >0.80 was considered negative. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. Results A total of 10 studies with 10919 patients with stable CAD (6919 FFRCT positive vs 4000 FFRCT negative) were included; mean follow-up was 17 months (ranging 3-56 months). There was no difference in risk of all-cause mortality in patients with FFRCT positive lesions compared to FFRCT negative lesions (OR 1.53, 95% CI 0.62-3.79; p=0.35). However, FFRCT positive lesions were associated with increased risk of MACE, AMI, and need for revascularization with PCI or CABG (OR 2.37, 95% CI 1.48-3.80; p<0.01; OR 4.6, 95% CI 1.58-13.41; p<0.01; OR 9.56, 95% CI 3.18-28.71; p<0.01). The overall incidence of revascularization in FFRCT negative patients was low compared to FFRCT positive patients (2.8% vs 31.7%). Conclusion FFRCT is a useful adjunctive modality for further risk stratification of patients with stable CAD. FFRCT positive lesions are associated with increased risk of MACE, AMI, and coronary lesions requiring revascularization.Figure 1

Association of microvascular dysfunction with cardiovascular outcomes in heart failure with preserved ejection fraction

Abstract Background Heart failure with preserved ejection fraction (HFpEF) is a disease that portends an increased risk of morbidity and mortality. Studies have reported an association between HFpEF and microvascular dysfunction, however this association and its prognostic significance remain unclear. The purpose of this meta-analysis is to evaluated the association of microvascular dysfunction with cardiovascular outcomes in patients with HFpEF. Methods A literature search was conducted for studies evaluating the association between microvascular dysfunction measured with global myocardial flow reserve (GMFR) and coronary flow reserve (CFR) and major adverse cardiovascular events (MACE) in patients with HFpEF. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. The minimum follow up duration was one year. Results A total of 5 studies with 448 patients (252 with HFpEF, 196 healthy controls) met inclusion criteria for evaluation of the association of GMPR with HFpEF. Patients with HFpEF had a significantly lower GMPR compared to healthy controls (SMD -0.83, 95% CI -1.03,-0.63; p<0.01). Heterogeneity was moderate: Chi2=9.5, df=4, I2 = 58%. Only 2 studies were identified that reported on the evaluation of CFR in patients with HFpEF so meta-analysis could not be reliably performed. A total of 4 studies with 591 HFpEF patients (284 with reduced CFR and 307 with normal CFR) met inclusion for evaluating the association with MACE. Mean follow-up was 36 months. Patients with impaired CFR <2.0 had significantly higher risk of MACE compared to patients with normal CFR (OR 8.89, 95% CI 3.77-20.92; P<0.01). Heterogeneity was low: Chi2=4.77, df=3, I2=37%. Conclusion Patients with HFpEF have significant microvascular disease compared to patients without HFpEF, which is associated with an increased risk of MACE. Additional high-quality studies are required to further elucidate this association and determine the utility of targeted medical therapy.

Association of myocardial infarction with nonobstructive coronary arteries with in-hospital outcomes

Abstract Background Myocardial Infarction with Non-obstructive Coronary Arteries (MINOCA) is a disease classification that is not uncommonly encountered yet poorly characterized. The association of MINOCA with in-hospital cardiovascular outcomes has been inconsistently assessed with studies reporting conflicting results. The purpose of this meta-analysis is to evaluate the association of MINOCA with in-hospital cardiovascular outcomes. Methods A literature search was conducted for studies reporting on the association of MINOCA with clinical endpoints as compared to obstructive coronary artery disease (OCAD). The primary end-point was in-hospital mortality. Secondary endpoints included cardiogenic shock (CS) on admission and congestive heart failure (CHF) during hospitalization. Databases searched included Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. Results 19 studies with 851,886 patients who had acute myocardial infarction (AMI) (45,475 patients with MINOCA, 80,6411 with OCAD) met inclusion criteria. Mean age was 63, 64% were male. Patients with MINOCA had significantly lower risk of in-hospital mortality compared to patients with OCAD (OR 0.42, 95% CI 0.31-0.57; p<0.01), the overall effect size was large (z=5.59). Patients with MINOCA had significantly lower risk of having cardiogenic shock on presentation compared to OCAD, however had no difference in risk of developing CHF during hospitalization (OR 0.45, 95% CI 0.35-0.58; p<0.01; OR 0.78, 95% CI 0.55-1.10; p=0.15). Conclusions Our results suggest that MINOCA is associated with lower risk of in-hospital mortality and lower risk of presentation with cardiogenic shock compared to OCAD. However, patients with MINOCA appear to have a similar risk of developing CHF during hospitalization compared to patients with OCAD.

Abstract 13211: Racial Disparities in the Association Between Early Repolarization Pattern and Cardiovascular Mortality

Introduction: The early repolarization (ER) ECG pattern has been associated with increased cardiovascular (CV) mortality, but it is unclear if there are racial differences in risk. Objectives: To evaluate racial differences in East Asian and Caucasian decent and the prognostic significance of ER. Methods: A literature search was conducted for studies reporting the association between ER and CV mortality endpoints. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. The minimum follow up duration was one year. Analysis was performed using odd ratios (OR). Results: A total of 16 studies and 189,422 participants (16,307 with ER vs 173,115 without ER) were included; mean follow-up was one year. ER was associated with increased CV mortality (OR 1.68, 95% CI 1.28-2.20; P<0.01). East Asian patients with ER had higher CV mortality compared to Caucasians (OR 3.94, 95% CI 2.2-7.04 vs. OR 1.32, 95% CI 1.03-1.70; P<0.01). (Figure 1-3) Conclusions: ER pattern is associated with increased CV mortality, particularly in East Asian patients.

Implementation strategies, facilitators, and barriers to scaling up and sustaining demand generation in family planning, a mixed-methods systematic review

BackgroundDemand generation aims to increase clients’ desire to use family planning. The aim of this work was to systematically summarize strategies, facilitators, and barriers to scaling up and sustaining demand generation in family planning.MethodsWe searched electronic bibliographic databases from inception to October 2022. We included quantitative, qualitative, and mixed methods reports on demand generation strategies in family planning, regardless of country, language, publication status, or methodological limitations. We assessed abstracts, titles and full-text papers according to the inclusion criteria, extracted data, and assessed methodological quality of included reports. We used the convergent integrated approach and a deductive thematic synthesis to summarize demand generation themes and subthemes. We used the health system building blocks to synthesize the factors affecting implementation (barriers and facilitators). We used GRADE-CERQual to assess our confidence in the findings.ResultsForty-six studies (published 1990–2022) were included: forty-one quantitative, one qualitative, and four mixed methods). Three were from one high-income country, and forty three from LMIC settings. Half of reports were judged to be of unclear risk of bias. There were unique yet interrelated strategies of scaling-up demand generation for family planning. Interpersonal communication strategies increase adoption and coverage of modern contraceptive methods, but the effect on sustainability is uncertain. Mass media exposure increases knowledge and positive attitudes and may increase the intention to use modern contraceptive methods. Demand-side financing approaches probably increase awareness of contraceptives and the use of modern contraceptive methods among poor clients. Multifaceted Demand generation approaches probably improve adoption, coverage and sustainability of modern methods use. Factors that influence the success of implementing these strategies include users knowledge about family planning methods, the availability of modern methods, and the accessibility to services.ConclusionsDemand generation strategies may function independently or supplement each other. The myriad of techniques of the different demand generation strategies, the complexities of family planning services, and human interactions defy simplistic conclusions on how a specific strategy or a bundle of strategies may succeed in increasing and sustaining family planning utilization.Trial RegistrationSystematic review registration: Center for Open Science, osf.io/286j5

Role of Ursodeoxycholic Acid in the Prevention of Gallstones Formation in Bariatric Patients-a Systematic Review and Meta-Analysis of Randomised Trials.

The aim of this meta-analysis was to assess whether treatment with ursodeoxycholic acid (UDCA) in patients who have undergone bariatric surgery reduces gallstone formation. A systematic literature search was performed using electronic databases (MEDLINE, Embase, CENTRAL, Web of Science, PROSPERO, Google Scholar and the WHO International Clinical Trials Registry platform). RCTs without restrictions on study language, year, status of publication and patient's age were used. Pooled risk ratios were calculated using a random-effects model. Subgroup analyses for drug dose, duration and procedure types were performed. Sensitivity analyses and a summary of findings table were generated to assess the robustness and the level of evidence provided, respectively. Fourteen trials were included (3619 patients, 2292 in UDCA vs 1327 in control group). Procedures included SG, RYGB, OAGB, AGB and Gastroplasty. UDCA dose ranged from 300 to 1200mg per day. Gallstone formation occurred in 19.3% (8.3% in UDCA vs 38.1% in the control group). UDCA significantly reduced the risk of gallstone formation (14 trials, 3619 patients; RR 0.27, 95% CI 0.18-0.41; P < 0.001). UDCA significantly reduced the risk of symptomatic gallstone disease (6 trials, 2458 patients; RR 0.30, 95% CI 0.21-0.43; P < 0.001). No subgroup difference was found for different doses, duration and type of procedure performed. Oral UDCA treatment significantly reduces the risks of developing gallstones in postoperative bariatric patients from 38 to 8%. The use of 500 to 600mg UDCA for 6months is effective and should be implemented in all patients post-bariatric surgery.

An Investigation of Students’ Research Self-Efficacy and Research Anxiety Levels

The goal of the current research is to present the degrees of students' scientific research self-efficacy and research anxiety as well as to look into the relationship between these two factors regarding various variables (department, gender, education level, profession, and having a scientific publication) in three departments; Special Education, English Language Teaching, and Science Education at Tokat Gaziosmanpaşa University. The findings of this study showed that participants' levels of research anxiety are low, that gender, scientific publication status, and department have no bearing on students' levels of research anxiety, but that participants' levels of education and profession significantly affected those levels. Additionally, the participants' levels of scientific research self-efficacy were generally moderate, and factors including gender, current educational attainment, employment status, prior scientific publication, and program type had no discernible effects on these levels. Additionally, a relationship between students' degrees of self-efficacy in scientific research and their levels of anxiety regarding it was found to be moderately positive and significant.